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General NPI Number Information
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NPI Number | 1154497212
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Entity Type | Organization
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Legal Business Name | ELIAS, ELLIOTT, LAMPASI, FEHN, & HARRIS ADP
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3487 CENTRAL AVE
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City | RIVERSIDE
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State | CA
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Zip | 92506-2115
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Country | US
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Telephone | 951-369-1001
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Fax |
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Provider Business Mailing Address
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Address Line | 3487 CENTRAL AVE
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City | RIVERSIDE
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State | CA
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Zip | 92506-2115
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Country | US
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Telephone | 951-369-1001
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | DON MA
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Credential |
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Telephone | 951-689-5031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 26841
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License Number State | CA
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